Nursing Home Pro

One thing I try to do is to learn from my mistakes.  So, I’ll share some of my mistakes in this section called Lessons Learned so hopefully you can learn from them, too.  The lesson we’ll talk about today is about family members coming to take your resident out of the facility. This incident happened to me several years ago when I was first starting out.

I was a new nursing home administrator working in one of my first facilities and, as most of us do, I was learning from the facility more than I was making changes.  We learn from the way the facility has always done things.  One such thing was the way this small town facility allowed any family members to come check the residents out.

We had a resident we’ll call John Doe at the facility.  He was your typical long term care, walkie-talkie resident, with just a touch of dementia.  He still made many basic decisions for himself, but his MDS stated that he had trouble making decisions in new situations.

Mr. Doe had a responsible party (RP) which was his daughter.  I didn’t really see her or her sister that often, but all-in-all he had a good, quiet family.  One day, his cousin Fred, who he was excited to see, came to visit him.  Mr. Doe told us he was going to town to grab a burger with Cousin Fred and he’d see us later that afternoon.  No big deal.  Sure enough, Cousin Fred dropped him off later that evening with no obvious issues.  Mr. Doe seemed happy that he saw Fred, and we thought nothing more of it……..until 2 days later when I received a phone call.

“Why did you let my father leave with that man?!” demanded Mr. Doe’s daughter.  “That man just got out of jail!  He took my father to the bank and withdrew all of his money!”

Ouch!  I felt horrible.  It was my facility that allowed this to happen.  Not only could I have been cited a serious deficiency if the State got ahold of this little bit of information, but I had let down my resident and his family.  I had no excuse.

From that point forward, I instituted a new protocol at every facility I managed:  No resident leaves with someone other than the responsible party without first notifying the responsible party.  Now, you come to an issue when the resident has not been adjudicated incompetent and their MDS states they can make their own decisions.  It doesn’t matter; I still notify the RP.  And, if the RP says No, I see if there is a way I can delay the trip until the RP can come to the facility and then I let them settle it themselves.

I also started asking upon the admission of any new resident and in care plan meetings who could visit and take out the resident and, more importantly, who could not visit or take the resident out.  That helps solve problems before they happen.

I observed a similar incident at another facility.  There was a problem resident, one that always complained, was combative with staff, and always wanted to go home.  I mean there was something with this resident everyday.  Her daughter was conservator and she said No, she couldn’t go home by herself.  There was no one there to assist her.  The resident convinced her cousin that he should come pick her up and take her home – she was sick of being in a nursing home when she had a perfectly good house she could live in.

The cousin did come and, in the midst of trying to take her out, the staff called the administrator.  The administrator made a terrible mistake.  Thinking that his prayers had been answered and this was a solution for the problem resident, he told the staff to let her go with the cousin and throw a party afterward!

Not surprisingly, the daughter was outraged when she learned the facility had allowed someone to take her mother home and drop her off at her house by herself.  She contacted the Ombudsman who contacted the State.  Four Immediate Jeopardy tags were cited and the facility faced termination of its Medicare/Medicaid provider agreement until these IJ’s were lifted.  The only way the IJ’s could be lifted was to get the resident back into a safe environment.

I rode along with the administrator as he drove to the home of the resident he allowed to discharge home unsafely with someone who was not her decision-maker.  Let me tell you, if you ever have to attempt to talk a resident – who didn’t want to be in a nursing home – into coming BACK to the nursing home after they’ve gotten back into their own house, it ain’t happening! There was no way this lady was going to come back with us.  And he tried everything.  The funny thing is the lady’s whole personality had changed once she got home.  She welcomed us into her home.  She offered us coffee and tea.  She was very pleasant.  No cursing or yelling.  She was happy.  It was sad to know that she couldn’t stay.

In the end, the sheriff’s department had to go out to the woman’s house and pick her up.  She was taken and admitted to another facility the family chose.  The administrator’s facility did get the IJ’s abated.  The administrator ended up losing his job soon after.  And, of course, his license got dinged, as well.  A rough ending to a bad situation.

I don’t ever want to be in that situation again, so, as part of my basic expectations, I drill this into my staff and include it into any new hire orientation.

Lesson learned!